Splenic infarction complicated with immune reconstitution inflammatory syndrome due to disseminated Mycobacterium genavense infection in a patient infected with human immunodeficiency virus

Hosoda, Tomohiro; Sakamoto, Mitsuo; Ohkusu, Kiyofumi

doi:10.1016/j.jiac.2019.05.023

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…5 , 6 Because no coagulation abnormalities were found in this case, infection was initially considered. Three cases of HIV infection have been reported as the infectious cause of splenic infarction, with two cases with Mycobacterium genavense infection 7 , 8 and one case with aspergillosis infection. 9 MAC infection as an etiology of splenic infarction has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…Mycobacterial cultures are not performed in most comprehensive hospitals in China, and a reliable method of molecular biological identification of NTMs remains a diagnostic challenge. Apart from conventional and time-consuming mycobacterial culture, polymerase chain reaction and 16s rRNA gene sequencing 7 , 8 or reverse hybridization DNA probes are used to identify the specific organisms of NTMs. As a culture-independent method, mNGS provides a rapid etiological diagnosis, especially in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Splenic infarction is extremely rare in human immunodeficiency virus (HIV)-infected populations. 3 – 9 To date, no MAC infection has been reported to cause splenic infarction in HIV-infected patients. We report a case of splenic infarction involving MAC infection in a patient with acquired immune deficiency syndrome (AIDS) and immune reconstitution failure.…”

Section: Introductionmentioning

confidence: 99%

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Splenic infarction due to Mycobacterium avium complex infection in an HIV-infected patient with immune reconstitution failure: a case report

et al. 2022

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Splenic infarction is extremely rare in human immunodeficiency virus-infected populations. We report a rare case of splenic infarction involving Mycobacterium avium complex infection in a patient with acquired immune deficiency syndrome with immune reconstitution failure. A young man was initially admitted with cryptococcus meningitis and found to be infected with human immunodeficiency virus. He had anti-cryptococcosis treatment performed in combination with placement of an Ommaya capsule because of persistent intracranial hypertension, and first-line therapy followed by second-line anti-retroviral therapy were performed. Although there was an absence of immune reconstitution, the patient refused to take prophylactic sulfamethoxazole/trimethoprim, isoniazid, and clarithromycin continuously because of gastrointestinal intolerance. Pneumocystis pneumonia then developed. Finally, the patient developed a fever again accompanied by abdominal pain and splenic infarction. M. avium complex infection was verified by a metagenomic next-generation sequencing test using a whole blood sample. M. avium complex infection should be considered as an etiology of splenic infarction in human immunodeficiency virus-infected patients with an extremely low CD4+T-cell count.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Splenic infarction due to Mycobacterium avium complex infection in an HIV-infected patient with immune reconstitution failure: a case report

et al. 2022

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“…Identification of the fastidious bacterium is generally challenging because it does not grow on solid media commonly used in mycobacterium culture. Recent advances in diagnostic techniques, however, have uncovered that M. genavense can cause infection in various organs including the lungs [4], spleen [5], and intracranial regions [6] and may cause aneurysms [7].…”

Section: Introductionmentioning

confidence: 99%

Disseminated Mycobacterium genavense infection mimicking TAFRO syndrome

Oka

Yamane

Yokota

et al. 2020

Journal of Infection and Chemotherapy

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TAFRO syndrome is a rare variant of idiopathic multicentric Castleman's disease, for which disseminated non-tuberculous mycobacteria (NTM) infection must be excluded. However, due to the slow and fastidious growth of the organisms, identification of the pathogen is often challenging. We herein describe a case of disseminated Mycobacterium genavence infection, in which manifestations of the patient were confusingly similar to those of TAFRO syndrome. A 69-year-old Japanese man presented with prolonged fever accompanying pain in his back and ribs on the right side. Systemic investigations revealed thrombocytopenia, marked elevation of alkaline phosphatase, anasarca (pleural effusion and ascites), megakaryocytosis in the bone marrow, and hepatomegaly. Magnetic resonance imaging (MRI) showed diffuse, T1-and T2-low-intensity spotted lesions on his vertebral bodies, but biopsy showed inconclusive results. The patient met the diagnostic criteria of TAFRO syndrome and was started on prednisolone, which improved his general condition shortly thereafter. Blood culture after 42 days of incubation revealed the presence of Mycobacterium; however, we considered it a contamination at that time because no organisms grew on conventional agars, and the patient was discharged. Ten weeks after the isolation of Mycobacterium, he developed persistent fever and was readmitted. This time, vertebral bone mallow biopsy demonstrated a large amount of mycobacterium, which was later successfully identified as M. genavense by sequencing analysis. Under a final diagnosis of disseminated M. genavense infection, we treated the patient with clarithromycin, rifampicin, and ethambutol. This case highlighted that disseminated NTM infection may follow a similar clinical course as that of TAFRO syndrome.

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Disseminated Mycobacterium genavense Infection Mimicking Sarcoidosis: A Case Report and Review of Literature on Japanese Patients

Ogata,

Kido,

Takeda

et al. 2023

Microorganisms

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Sarcoidosis is a systemic inflammatory disease characterized by noncaseating epithelioid cell granulomas. However, certain infections can exhibit similar histological findings. We present a case of a 69-year-old man who was initially diagnosed with sarcoidosis and later was confirmed, through 16S rRNA sequencing, to have disseminated Mycobacterium genavense infection. Acid-fast bacteria were detected in the bone marrow biopsy using Ziehl–Neelsen staining, but routine clinical tests did not provide a definitive diagnosis. The patient tested negative for HIV, anti-interferon-gamma antibodies, and genetic immunodeficiency disorders. He was treated with multiple drugs, including aminoglycosides and macrolides, but showed no improvement in fever and pancytopenia. However, these clinical signs responded favorably to steroid therapy. We reviewed 17 Japanese cases of M. genavense infection. All cases were in males; 7/17 (41%) were HIV-negative; and 12/17 (71%) had a decreased CD4 count. Genetic analysis confirmed M. genavense isolation, and macrolides were used universally. Mycobacterium genavense infection is challenging to identify and mimics other systemic inflammatory diseases such as sarcoidosis. There are no standard treatment protocols. Our case report and Japanese case review contribute to understanding this rare disease.

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Splenic infarction complicated with immune reconstitution inflammatory syndrome due to disseminated Mycobacterium genavense infection in a patient infected with human immunodeficiency virus

Cited by 4 publications

References 13 publications

Splenic infarction due to Mycobacterium avium complex infection in an HIV-infected patient with immune reconstitution failure: a case report

Splenic infarction due to Mycobacterium avium complex infection in an HIV-infected patient with immune reconstitution failure: a case report

Disseminated Mycobacterium genavense infection mimicking TAFRO syndrome

Disseminated Mycobacterium genavense Infection Mimicking Sarcoidosis: A Case Report and Review of Literature on Japanese Patients

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